The High Cost of Giving Up Your Eggs

To a cash-strapped student, the typical $8,000 payment can seem tantalizing. But donors say the money is fully earned.

The eggs of healthy, well-educated young women are in such high demand that one top New York clinic has taken to advertising for them at the movies. The ads make egg donation look gentle and simple — and never fail to point out that donors will be paid $8,000, the going rate.

But some wonder if cash-strapped young women, who may be facing high college and other bills, realize that it’s far harder than it looks.

“When I was first considering being a donor, I was really misinformed about the process,” said seven-time donor E.D., 30, who asked that only her initials be used, due to her confidentiality agreement with the Washington Fertility Center in Washington, D.C. E.D., now a scientist, was a 25-year-old graduate student the first time she donated her eggs.

She underwent extensive testing, was checked for communicable diseases and abnormalities, and met with a genetic counselor. During a psychological screening, she was asked what connection she would feel to any offspring, since she had to sign away her legal rights as a parent.

Once chosen — only a small percentage of applicants are — she was put on birth control to synchronize her menstrual cycle with the recipient’s. For about two weeks, she injected herself twice daily with the hormone stimulant Lupron, which shuts down the normal ovarian process. At 35 hours before retrieval, she had to give herself what she calls “the big shot,” which stimulates the ovaries to produce extra eggs.

On retrieval day, E.D. was anesthetized while a needle was inserted through her vaginal wall to withdraw 20 to 30 eggs, each about the size of a dot.

The process took about six weeks, and six more for her body to re-adjust.

Then she had a scare. She experienced “ovarian hyperstimulation” — a serious potential side effect of egg donation.

“I first realized something was wrong when I couldn’t breathe,” E.D. said. “I gained 17 pounds over three days. Everything hurt. I looked pregnant. I was completely freaked out.”

The clinic put her on a high-salt diet to eliminate water weight. Fortunately, her case was mild. It took her two weeks to recover. Serious cases — which researchers say happen in less than one percent of donations — require hospitalization.

“It is a medical procedure, and there are possible complications,” cautioned Dr. Frederick Licciardi, director of the New York University fertility center’s egg donor program. Most donors get headaches, bloating, moodiness and other common period-like symptoms.

It’s also easier for donors to get pregnant accidentally, since treatment makes them highly fertile.

“I was married while I was doing the donation and we never felt like our sex life was disrupted,” E.D. said. “You can have sex during the whole process-with a condom. A couple days before the retrieval your ovaries are pretty swollen, so it can be uncomfortable to have, let’s say, vigorous sex, but you can still do it.”

Blood clots, and bad reactions to hormone injections, are other potential risks. Five donors in the United Kingdom have died from donation-related complications -the most recent case in August 2006, when a donor bled to death after her artery was punctured during retrieval.

Nor is there any conclusive information about long-term effects on the donor. Licciardi admits that his clinic does not have the resources to investigate. “The follow-up just isn’t possible,” he said.

“There’s not very much data about the long-term health risks, especially risks resulting from the hormones,” said Emily Galpern, project director of reproductive health and human rights at the Center for Genetics and Society in Oakland, Calif. “There needs to be large, long-term studies done,” she said, especially about the link between egg donation and cancer.

Studies showing links with ovarian cancer, and on the long term-effects on donor fertility, are both inconclusive.

“There isn’t a lot of good follow-up on fertility of donors,” says Dr. Lynn Westphal, a gynecologist and director of the Women’s Health program at Stanford University. “But we think that unless they have some unusual complication it should not affect their fertility. Anecdotally, I have a number of people who have donated for relatives, and then have gone on to become pregnant without any difficulty.”

There can be psychological impacts, too: foremost, there will be a child out there (or possibly two, since half of in vitro procedures result in multiple births).

Nancy Kenney, professor of psychology and women’s studies at the University of Washington, just completed a study of 80 former donors.

“Very little is known about egg donation from the perspective of the women who donate their eggs,” she said.

One former donor, who blogs about her experience under the name Amy, wrote: “I am a 37-year-old mother of two, and am currently suffering the aftermath of donating my eggs when I was 20 years old. I am not suffering physically at this time, but emotionally.”

“Amy”` said on her blog that she obsesses over how the child has turned out, if he or she is happy and healthy, and if the child knows he’s a product of egg donation.

“What happens if my daughter ends up going to the same college and dates this person? she wondered. “These are things I did not consider as a 20-year-old in need of extra money.”

Given risks, stresses and inconveniences, most people interviewed argued that the typical $5,000 to $8,000 payment is fully earned.

“It’s supposed to be a donation,” says Dr. Westphal. “I think it’s reasonable for them to get compensated for the time and effort they put into it, but the compensation should be in line with what they’re going through.”

But some donors are rumored to be paying much more. Ads in college newspapers, such as University of California at Berkeley’s “Daily Californian,” offer $25,000, $65,000, or even six-figure sums, for “exceptional” donors — attractive people with perfect SAT scores or who belong to certain ethnic groups.

This raises concerns about genetic engineering, and motivation, Westphal said. “These huge sums of money I think make some people do it who would not otherwise do it.”

No federal law regulates donor fees, though Arizona and California have proposed legislation to either outlaw or cap them. But most other industrialized nations, including Canada and Britain, ban the practice of paying donors fees. That’s led to a donor shortage, and drives many infertile couples to seek treatment in the United States.

“I think that’s insane and wrong,” E.D. said, of the idea of a payment ban. “It’s a tremendous investment of time and energy.” She admits: “The financial part was a little bit of my motivation. But I really think I would have done it even if there was no money.”

New York University runs a leading in-vitro fertilization clinic. Young women who donate their eggs so others can have children say they don't always understand the complications involved. Photo by Nick Judd.